Q&A With Contagion‘s Science Advisor (Plus Spoilers!)

If you are a disease geek, then yes, you will love Contagion, the all-star Oh God Oh God We’re All Going To Die movie that opened last night. Paramyxovirus! R-nought! BSL-4! And, bonus, so many insider references to the CDC that the script could double as an epidemiology drinking game. (Go to the end of this post for my fact-check of CDC references. They’re spoilery and thus hidden on the next page.)

To me, the fascinating thing about Contagion is how seriously it takes its epidemiology, its virology and even its sober sense of how unprepared most Americans are for a mass-casualty disaster (as captured in this April report from the National Biosurveillance Advisory Committee).

To find out where those came from, I asked its chief science adviser: Dr. W. Ian Lipkin, who is the John Snow Professor of Epidemiology, and Director of the Center for Infection and Immunity, at Columbia University’s Mailman School of Public Health, dubbed a “master virus-hunter” by master science-writer Carl Zimmer in the New York Times. Here’s our email Q & A.

Maryn: Given past “science” movies — Outbreak, for instance — I was surprised that the science in this movie is so solid. Was this your doing, and how did you manage it?

Lipkin: Scott Z. Burns and Steven Soderbergh insisted that Contagion be firmly grounded in fact. You won’t see footnotes; nonetheless, choices were carefully researched and vetted. Actors met with people whose work they represented in laboratories and the field. Where feasible we used bona fide equipment in lab scenes. My colleagues and I were on set for critical scenes to address questions from Soderbergh, actors and other artists, or to help with dialogue or makeup on the fly. We want viewers to understand and appreciate what is needed to protect them and their loved ones. Contagion is a work of fiction but it’s based on fact not fantasy.

M: You and your Columbia colleagues designed the viral villain and its syndrome. Why did you choose what you did?

L: [The fictional] MEV-1 is a paramyxovirus that infects the lungs and the brain. It was modeled on Nipah virus because we wanted something more interesting cinematically than an agent that causes only respiratory distress. We do a lot of work on Nipah surveillance in Bangladesh and have produced immunological therapeutics that we hope will be effective in preventing or ameliorating the effects of Nipah encephalitis. I can’t exclude the possibility that influenced my thinking; nonetheless, the choice was perfect in that it gave us a link to bats and pigs as well as an interesting clinical presentation. We considered casting other viruses but this was the best.

M: While MEV-1 is the actual bad actor, the movie has a second villain: the corrupt blogger specifically, and more generally both the Internet and the traditional media. Can you expand on how important it is to address the spread of fear and rumor along with viral spread?

L: People like [Jude Law’s character] Alan Krumwiede can be dangerous as well as exploitative. They prey on our fears, consume precious resources and may discourage us from pursuing real solutions. On more than one occasion I’ve heard Steven Soderbergh lament the fact that there is no vaccine against stupidity. Perhaps Contagion is that vaccine. If it is, I expect the studio will remind us of the importance of booster shots at regular intervals.

M: There’s an interesting contrast in the film between what civilian characters say about the epidemic — several times, we hear “You public health people were wrong about H1N1” — and how severe MEV-1 eventually becomes: large-scale quarantine, breakdown of food delivery, mass graves. Did you mean to send a message, that this is what preparedness really looks like?

L: Hope for the best, prepare for the worst. One of the sad facts of public health is that if we do our jobs well no one sees us. How many of us are prepared for an earthquake, fire, or other disaster with water, batteries or even an emergency contact plan for loved ones?

M: Warner Bros. has sold this pretty simply as a horror-thriller. What are the issues you want people to take away from this movie and think about afterward?

L: The Royal Astronomer, Martin Rees, predicts that a serious biological threat will emerge to claim at least one million lives by 2020. Only time will tell whether he’s right or wrong. Nonetheless, I’m appreciative that he has focused the thinking of many influential people on the need for preparedness. Support for science and public health is eroding just when we need it most.

And now: Spoilers! Click through to the next page for a quick run-down on what’s real and what’s fictional in Contagion‘s science-studded script.

Maryn: After the excesses of GOOP, we can only hope. Kidding! She develops a fever and cough, she goes all neurological, and she dies ugly, in a couple of days. As Lipkin says above, the fictional MEV-1 (the name is never explained, but presumably it stands for MeningoEncephalitis Virus — meningoencephalitis, inflammation of the brain and its covering, can cause fever, tremor and convulsions) is based in part on real-life Nipahvirus, which was identified in 1999. Nipah does cause fever and headache leading to coma, but in 14-16 days, not four.

ISR:Is that really the CDC on-screen?

M: Mostly yes. The deck where (CDC division chief) Laurence Fishburne parks and the stone wall he stands next to while talking to (janitor) John Hawkes are the actual outside of Building 19, which houses the CDC’s Visitor Center. The giant video screens in front of which Fishburne is interrupted by (Department of Homeland Security official) Enrico Colantoni is the actual Bldg. 19 lobby, and the driveway late in the film where Fishburne has to thread his way through a riot is the actual CDC front gate. CDC insiders tell me though that the EOC, where Fishburne meets up with (Rear Admiral Haggerty) Bryan Cranston, is a set that precisely reproduces the actual EOC.

ISR: About that acronym — what’s with the alphabet soup?

M: OK, quick primer:

EOC: the CDC’s Emergency Operations Center, its post-SARS war room.

BSL-4: “biosafety level” 4 on a scale of 1 to 4 — the highest level of laboratory containment, used for highly infectious organisms for which there is no vaccine or treatment, including the fictional MEV-1.

SOHCO: Single Overriding Health Communication Objective, the top-level message that public health people strive to impart in every communication with the public.

R-0 (pr. “R-nought”): Shorthand for the “reproductive number,” or number of cases of disease that are caused by a single case; when the reproductive number is determined, the appropriate numeral is subbed out for the 0. As in, I have flu, I give it to you, you have flu: Voila, R-1.

EISO: Epidemic Intelligence Service Officer, a member of the CDC’s crack corps of young disease detectives, who serve for two years immediately after finishing medical residency or post-graduate fellowship, or finishing a Ph.D.

ISR: Gwyneth Paltrow’s character brings the illness back to Minneapolis, and then Fishburne sends EISO (ooh, I feel all insidery!) Kate Winslet to work with the Minnesota Department of Health — who seem kind of jerky. Real?

M: Not real — in fact, probably a public-health joke. Minnesota may be the top health department in the country and routinely solves outbreaks on behalf of other, less well-funded states.

ISR: And then Winslet dies on the job. Has that ever happened?

M: Fortunately, not yet. The only EISO to die in the line of duty was Paul Schnitker, who was on assignment to the relief operations for the Biafran famine when his small plane was shot down in 1968. No EISO has ever been fatally infected by an organism he or she was investigating. (If they’ve caught something minor such as a foodborne illness, they’re not fessing up.)

ISR: In the last scenes, we see where MEV-1 came from: Paltrow’s company cleared a forest, disturbing a colony of bats; a bat lands in a palm tree and eats a piece of fruit; it flies away with the fruit and drops it into a pig pen; one of the piglets eats the fruit; and then the piglet ends up being butchered by a chef in the casino where Paltrow is gambling. In the last shot, she shakes hands with him. Real?

ISR: So, bottom line: If this really happened, we’d be fine, right? In the movie, millions of people die, but within about 4 months, a vaccine is being distributed worldwide.

M: And that’s probably the movie’s biggest fictional misfire. In reality, identifying a new virus, formulating a vaccine through 57 separate formulas, mounting human trials, getting it approved by national health authorities and then getting it manufactured, shipped around the world and shot into arms or noses would take much longer. If anything like MEV-1 — or any truly novel organism — ever emerges, the vaccine cavalry will take a long, long time to arrive.

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